The accord bp trial was a study of a treat ment strategy to achieve specific systolic bloodpressure goals, rather than an evaluation of any specific drug regimen. The accord lipid therapy trial was designed to test the effect of a therapeutic strategy that uses a fibrate to raise hdlc and lower triglyceride levels and uses a statin for treatment of ldlc reduce the rate of cvd events compared to a strategy that only uses a statin for treatment of ldlc on cardiovascular outcomes in patients with type 2 diabetes that were at high risk for cardiovascular disease. Apr 22, 2011 the accord lipid trial used fenofibrate because 1 data from the fenofibrate intervention and event lowering in diabetes field trial indicated that the risk of myositis when fenofibrate was combined with a statin was negligible. We assessed 10 251 adults aged 4079 years with established type 2 diabetes, mean glycated haemoglobin a 1c hba 1c concentration of 67 mmolmol 83%, and risk factors for ischaemic heart disease enrolled in the accord trial. Action to control cardiovascular risk in diabetes accord. Type 2 diabetes primarily affects adults, however recently type 2 has begun developing in children. This randomized control trial rct sets out to test if there is a correlation between a1c and cardiovascular cv events. Action to control cardiovascular risk in diabetes accord trial.
The federallyfunded accord study of patients with type 2 diabetes and cardiovascular disease or high risk of cvd randomized patients to intensive therapy, n5,057 target hba1c files, the va death files, and the national death. The cord study is an australiawide pilot trial which will investigate whether cord blood can be used to prevent or delay the development of type 1 diabetes. This randomized control trial rct sets out to test if there is a correlation between. Accord diabetes trial intensive versus standard a1c targets in. The design of the active portion of our study and the main results were published previously. Pdf the accord trial and control of blood glucose level in. Accord study group and of the writing committee for this report appears in the appendix. The impact of frequent and unrecognized hypoglycemia on. Most patients with type 2 diabetes mellitus develop cardiovascular disease cvd, with substantial loss of. Rational goalsetting and management of diabetes in the.
The dais diabetes atherosclerosis intervention study investigators data a very successful angiographic. Intensive glucose control in patients with type 2 diabetes. It has over 10,000 participants between the ages of 40 and 82 who have been involved with the. The action to control cardiovascular risk in diabetes accord study was a large, multicentre, prospective, randomised, controlled trial that was supported by the us national heart, lung and blood institute, the national institute of diabetes and digestive and kidney diseases, the national eye institute and the centers for disease control and. Module 7 drug treatment in type 2 diabetes with hypertension. Accord stands for action to control cardiovascular risk in diabetes. Clinical implications of the accord trial the journal of clinical. The federallyfunded accord study of patients with type 2 diabetes and cardiovascular disease or high risk of cvd randomized patients to intensive therapy, n5,057 target hba1c accord cohort abbreviations. Hazard ratios 95% cis relating the risk of death to the updated annualized number of hypoglycemic episodes and the updated annualized number of intervals with unrecognized hypoglycemia were obtained using cox proportional hazards regression models. To be eligible for the study, participants also had known heart disease or at least. Accord blood sugar treatment strategy telebriefing february 06, 200810. General commentary on diabetes by william mcgarey, m. Some, but not all, studies have shown that lowering hba 1c levels reduces cardiovascular risk, and these data have been used to support current guidelines that recommend a target hba 1c level of. Advance collaborative group, patel a, macmahon s, et al.
Effects of combination lipid therapy in type 2 diabetes mellitus. The action to control cardiovascular risk in diabetes accord trial sought to explore whether more intensive glucose control regimens were associated with better outcomes in patients with type 2 diabetes mellitus. Accord which stands for action to control cardiovascular risk in diabetes involved type 2 diabetics at high risk for heart problems. People with diabetes, high hba 1c concentrations 75%, and cardiovascular disease or. Study microvascular cvd mortality ukpds1,2 dcctedic3. However, all the antihy pertensive regimens were to include drug classes that had been shown to result in a reduction in cardiovascular events among participants with diabetes. Kingdom prospective diabetes study ukpds has shown an 11% decrease in risk with each 10 mmhg reduction of systolic blood pressure.
In addition, accord participants had blood sugar levels that were higher than most type 2 diabetes patients in the u. The accord action to control cardiovascular risk in diabetes. Review article antidiabetic medications and risk of macular. People with type 2 diabetes are at elevated risk for a number of serious health problems, including cardiovascular disease, premature death, blindness, kidney failure, amputations, fractures, frailty, depression. Kdoqi clinical practice guideline for diabetes and ckd. The accord lipid trial used fenofibrate because 1 data from the fenofibrate intervention and event lowering in diabetes field trial indicated that the risk of myositis when fenofibrate was combined with a statin was negligible. The study of more than 10,000 participants is sponsored by the national institutes of health. The cord study can cord blood prevent type 1 diabetes. The accord study was a maximum effort to determine whether. Dec 18, 2014 the study, known as the action to control cardiovascular risk in diabetes accord trial, is being conducted at 77 sites in north america.
Accord diabetes trial intensive versus standard a1c targets. Accord is one of the largest studies ever conducted in adults with type 2 diabetes who were at especially high risk of cardiovascular events, such as heart attacks, stroke, or death from cardiovascular disease. Methods study design accord was a randomized trial conducted at 77. Racgp the use of fenofibrate in the management of patients. A study investigating a monoclonal antibody to t cells, teplizumab, in preventing type 1.
Clinical sites consent documents are kept at the coordinating center. They also experience increased rates of nonfatal myocardial infarction and stroke. Actions to control cardiovascular risk in diabetes accord eye study type 2 diabetes 2003 2009 three medical therapies n10,251. Accord was a parallelgroup, randomised trial done in 77 clinical sites in north america. Hazard ratios 95% cis relating the risk of death to the updated annualized number of hypoglycemic episodes and the updated annualized number of intervals with unrecognized hypoglycemia were obtained using. Insulin dose and cardiovascular mortality in the accord trial.
We present here the main results of the accord bp trial. Effects of intensive glycaemic control on ischaemic heart. Since these studies showed for the first time that glycaemic control to targets under 200 mgdl and an hba1c of 7 percent had substantial. Jensen june 12, 2008 accord diabetes trial1 intensive versus standard a1c targets in t2dm mortality with a very intensive glucose lowering strategy in high cv risk t2dm patients research question. Type 2 diabetes is much more common and accounts for 9095% of all diabetes. Landmark accord trial finds intensive blood pressure and. Accord study in the action to control cardiovascular risk in diabetes accord study, 10251 adults with type 2 diabetes mean age, 62 years. We do have previous data with fibrates in diabetics or tghdl axis disorders. Participants were assigned to intensive or standard therapy target hba 1c less than 42 or 5363 mmolmol less than 60% or 7079%.
Accordion the accord followup study is a prospective, observational followup study of at least 8000 participants who were treated and followed in the action to control cardiovascular risk in diabetes accord trial. In 2008, the results of the glucose control study raised some eyebrows. Nejm 2010 on face value the trial seems to be null on the ability of fenofibrate to improve outcomes in t2dm patients. There does appear to be a genetic component to type 1 diabetes, but the cause has yet to be identified. Accord study group and accord eye study group, effects of medical therapies on retinopathy progression in type 2 diabetes. It has over 10,000 participants between the ages of 40 and 82 who have been involved with the study for between two and seven years. In the hypertension optimal treatment hot study, there was a 51% reduction in cardiovascular events in diabetics with target diastolic bp diabetes accord blood pressure trial accord bp 4 tested the effect of a target systolic blood pressure below 120 mm hg on ma jor cardiovascular events among highrisk persons with type 2 diabetes. Effects of intensive glucose lowering in type 2 diabetes nejm.
One study of people with type 2 diabetes, the united kingdom prospective diabetes study, demonstrated that controlling blood glucose levels reduced the risk of diabetic eye disease and kidney disease. At present, the relationship between adm intake including insulin injection and oral amd and incidence of macu lar edema is still unclear. A total of 10,096 accord study participants with followup for both hypoglycemia and mortality were included. Accord diabetes trial intensive versus standard a1c. The study is being led by associate professor maria craig, a paediatric endocrinologist at the childrens hospital at westmead. What does the news about the accord study mean to you. Accord action to control cardiovascular risk in diabetes. Edic epidemiology of diabetes interventions and complications. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes. Followup of glycemic control and cardiovascular outcomes. In patients with diabetes, high glycated hemoglobin hba 1c levels are associated with elevated risks for cardiovascular events and death.
Est page 2 leadership of the accord clinical trial will make statements. Effects of intensive bloodpressure control in type 2. Rational goalsetting and management of diabetes in the elderly. Prior to the accord trial, several randomized controlled trials had been conducted regarding blood sugar control in. Followup of glycemic control and cardiovascular outcomes in. This appendix has been provided by the authors to give readers additional information about their work. A large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. Other studies of the role of blood glucose control in people with type 2 diabetes are still under way. Vitamin d to prevent type 2 diabetes the d2d study the primary aim of the d2d study is to determine the effectiveness of vitamin d is preventing type 2 diabetes mellitus. And in this trial there was a positive result with a 33% reduction in progression of retinopathy in patients who were. In this randomized study, 10,251 patients mean age, 62. The accord study is a federally funded clinical study designed to figure out whether extremely tight blood glucose control reduces heart attacks and other cardiac problems in diabetics. Treatment in accord ended in 2009 and accordion is designed to further elucidate and clarify the long. Type 2 diabetes mellitus is a metabolic disease that is diagnosed on the basis of sustained hyperglycemia.
In brief, inclusion criteria for participants included type 2 diabetes, an a1c of 7. Longterm effects of intensive glucose lowering on cardiovascular outcomes. Review article antidiabetic medications and risk of. Read about the role of gastric bypass surgery in managing type 2 diabetes and obesity on page 8. Accord, action to control cardiovascular risk in diabetes, accordion, action to control cardiovascular risk in diabetes posttrial, uacr, urine albumincreatinine ratio, egfr, estimated glomerular filtration rate, eskd, endstage kidney disease. The accord action to control cardiovascular risk in. Introduction to the edgar cayce readings on health and healing 5 b. Implications for patients with type 2 diabetes harlan m. Dcct and edic national institute of diabetes and digestive. Accord diabetes trial1 intensive versus standard a1c targets in t2dm mortality with a very intensive glucose lowering strategy in high cv risk t2dm patients research question.
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